Category: From Newswise – Addiction

UNDER EMBARGO UNTIL
Wednesday, October 25 at 11am EST
Media Contact: Elizabeth Dowling
Mount Sinai Press Office

Dysregulation of the Brain’s Reward Learning System Is Identified by Scientists as a Potential Driver and Treatment Target for Cocaine Addiction 

Newswise — New York, NY (October 23, 2023) –A Mount Sinai-led team of researchers has shed new light on the ways in which cocaine addiction dysregulates the normal function of dopamine neurons and thus the brain’s ability to process and respond to reward-related information, making it more difficult for individuals to change their addictive behaviors.

Their insights into the neural mechanisms that mediate and maintain continued cocaine use, reported in the journal Neuron, could potentially lead to interventions to modify and even prevent this addiction.

“Previous research, mostly in animal models, has suggested that chronic cocaine use degrades the normal functioning of dopamine, a neurotransmitter widely implicated in reward, motivation, and learning,” said Rita Z. Goldstein, PhD, the Mount Sinai Professor in Neuroimaging of Addiction at the Icahn School of Medicine at Mount Sinai and senior author of the work.

“In people with chronic cocaine addiction we observed a striking reduction in the way their reward system—a set of connected regions along the brain’s dopamine pathways—responds to the outcomes of the person’s decisions,” Dr. Goldstein added. “Instead of signaling clearly when an unexpected reward was received and broadcasting this information throughout the brain to inform future decisions, the signal was attenuated, making it harder to learn from experience and modify decision-making to obtain better outcomes. This finding could potentially inform therapeutic strategies to target addictive cocaine use behaviors, which are especially difficult to change since this system is not functioning properly.”

The study was designed to investigate whether people with chronic cocaine use disorder demonstrate differences in how their brains process and represent prediction “errors”—discrepancies between what an individual expects to receive as a reward and what they actually receive. This difference is used as a “teaching signal” by the brain to guide learning and adaptive decision-making.

For their study, researchers used a simple decision-making task inspired by studies of dopamine neurons in animal models to measure different kinds of reward responses in the ventral striatum, a brain region that receives dense dopaminergic inputs. The results showed that prediction error responses in the ventral striatum reflected “utility” prediction errors—errors that incorporate an individual’s subjective experience of reward as informed by their unique preferences for risk and uncertainty. Importantly, utility prediction error responses were found to be significantly reduced in people with cocaine addiction, who were generally more risk-tolerant, especially those who began using cocaine in early adolescence.

“Our work firmly establishes that compared to non-addicted individuals, and despite generally intact reward expectations, people with cocaine addiction demonstrate weaker responses to actual rewards in the brain’s reward system, particularly the ventral striatum,” explains Anna Konova, PhD, Assistant Professor of Psychiatry at Rutgers University and first author on the study. “This is important because these responses are crucial for the fidelity of the prediction error signal as a teaching signal. A reduced reward signal may contribute to addictive behavior by diminishing an individual’s ability to respond to the harmful effects of a drug, or the value of other, healthier alternatives to drug use.”

Researchers suggest that understanding the precise mechanisms of prediction error alterations that drive addiction could lead to novel, targeted interventions designed to restore the aberrant teaching signal. More specifically, their study points out that therapeutic strategies that aim to boost the impact of one’s decisions—namely the perception of received rewards—could be valuable for normalizing prediction error signaling and the ability of the individual to learn from their addiction experiences.

“We’ve gone further than any prior study to characterize the mechanistic source of prediction error disruptions in people with clinically defined cocaine disruption and believe researchers can build on these findings to explore innovative new treatments and prevention strategies,” said Dr. Goldstein. She also serves as Director of the Neuroimaging of Addictions and Related Conditions (NARC) Research Program at Icahn Mount Sinai.

About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals” and by U.S. News & World Report‘s® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2023-2024.

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Newswise — Highly vulnerable patients with alcohol use disorder (AUD) or substance use disorder (SUD) who received regular assessments after their initial intervention had substantially better outcomes a year later than those who did not receive the same follow-up, according to a new study. Fewer than one in ten people with SUD receive any form of treatment in a given year; among those who do, relapse and treatment reentry are common. A Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocol is intended to facilitate treatment referrals, especially among patients with more severe SUDs, but research has shown it to be relatively ineffective in that regard. Adding a Recovery Management Checkup (RMC) intervention can improve treatment rates; RMC conceptualizes AUD and SUD as chronic conditions requiring longer-term monitoring via regular check-ins, early re-intervention in cases of relapse, and treatment retention strategies. For the study in Alcohol: Clinical & Experimental Research, investigators explored the impact of quarterly RMC checkups over 12 months on treatment and substance use among patients at Federally Qualified Health Centers (FQHCs), medical facilities serving populations experiencing socioeconomic hardship and often multiple chronic conditions.

Researchers worked with 266 participants in four FQHCs in Chicago, recruited between 2017 and 2020, who had moderate to high scores on an alcohol or drug screening test. Participants were predominantly male (65%) and African American (81%). In the past year, almost half had experienced homelessness, and fewer than half had been employed; most had problems related to physical and mental health and stress. All participants were referred for treatment. They were randomized to receive either SBIRT only or SBIRT followed by RMC. They were assessed at the start of the study and three, six, nine, and 12 months later. Those in the RMC group received personalized feedback and guidance using motivational interviewing and reinforcement of abstinence or support with reduced use and treatment. Urine testing initially confirmed the broad accuracy of participants’ reports, though it was discontinued during the COVID-19 pandemic. The investigators used statistical analysis to explore associations between the two intervention approaches and rates of treatment and substance use.

Quarterly checkups were associated with significant improvements in treatment initiation and reduced use of alcohol and cannabis, the most common substances. Over 12 months, participants assigned to SBIRT + RMC were more likely to attend treatment (61%) and received more days of treatment (mean 54 days) than those receiving SBIRT only (33%; mean 27 days). Those receiving RMC also reported, on average, more days of abstinence (173 compared to 140) and fewer days of alcohol and cannabis use, and had lower alcohol and drug use severity scores. More days of treatment was shown to be the mechanism for more days of abstinence. The use of opioids (e.g., heroin) and stimulants (e.g., cocaine) did not differ between the two groups, however.

The study confirmed the value of using RMC to improve patients’ linkage to treatment following SBIRT at FHQCs and demonstrated the added value of three subsequent checkups over 12 months. Among high-need populations, repeated assessments and connections to treatment may be a necessary element of care. More research is needed on the cost-effectiveness of RMC, which populations benefit most, and the real-world sustainability and scalability of the intervention.

A randomized controlled trial of recovery management checkups for primary care patients: Twelve-month results. C. Scott, M. Dennis, C. Grella, D. Watson, J. Davis, M. Hart. (pp xxx)

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Newswise — Adults aged 60 and older reported better overall health and quality of life after treatment for their alcohol use disorder, according to a new study published in Alcohol: Clinical and Experimental Research. Both male and female study participants also reported improvements in specific quality of life measures, including physical and psychological health, social relationships, and other environmental factors (e.g., including home environment, financial resources, transportation), and these improvements continued over time. The study supports the value of treatment of alcohol use disorder in older men and women, whose alcohol use disorder tends to be misdiagnosed and undertreated.

The study found small but significant improvements after treatment throughout the year-long study in overall perceived health among study participants. Improvements in overall perceived quality of life were significant in the short-term; and specific quality of life domains saw improvements that were maintained: physical health, psychological health, social relationships, and environmental health. Gender was not associated with changes in any quality of life outcome measure.

In general, quality of life refers to an individual’s perceptions of how well they are doing in various domains, e.g. physical health, such as energy, pain, and fatigue; psychological health, such as self-esteem and positive and negative feelings; social relationships, e.g., personal relationships and social support; and environmental health, such as financial resources and engagement in recreational opportunities.

The purpose of this study was to examine how treatment for alcohol use disorder affected the quality of life of adults aged 60 and older and whether quality of life outcomes differed by gender. Researchers analyzed data from a single-blind randomized control study of almost 700 adults aged 60 and older diagnosed with alcohol use disorder, conducted at sites in Denmark, Germany, and the United States from 2014 to 2016. Participants received weekly treatment for up to 12 sessions and were asked to report on various measures, including drinking and quality of life at four, 12, 26, and 52 weeks. Seventy-one percent of participants reported reductions in the number of days they drank.

Older adults are more vulnerable to alcohol’s harmful effects, such as falls and accidents, and to the positive effects of treatment for alcohol use disorder. Yet, prior studies have suggested that alcohol use disorder is under-detected and undertreated in older adults, possibly because healthcare providers may believe that treatment is unlikely to benefit older adults. This study demonstrates the benefit of screening and treating older adults for problem drinking and the value of quality-of-life measures in assessing treatment effectiveness. It is unclear whether the study’s findings can be generalized to older adults from countries not included in this study, people with co-occurring health and mental health issues, or those with less severe levels of alcohol use.

Improvement in quality of life among women and men aged 60 years and older following treatment for DSM-5 alcohol use disorder. J. Tryggedsson, K. Andersen, S. Behrendt, R. Bilberg, M. Bogenschutz, G. Buehringer, A. Søgaard Nielsen. (pp xxx)

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Newswise — SAN FRANCISCO — Although people with opioid use disorder (OUD) are significantly more likely to overdose or have a complication after major surgery than those without the disorder, using medications for the treatment of OUD before surgery may eliminate that extra risk, suggests a large, first-of-its-kind study presented at the ANESTHESIOLOGY^® 2023 annual meeting.

Patients with OUD who didn’t use an OUD medication (such as buprenorphine or methadone) were over four times more likely to overdose after having surgery, yet those who used evidence-based OUD medication before surgery were essentially at no greater risk than those who didn’t have OUD, according to the study. Taken orally, OUD medications reduce withdrawal and cravings and prevent opioids from producing the feeling of euphoria that drives addiction.

“We know that OUD treatments are very effective in helping to prevent relapse, overdose and death in nonsurgical patients, but our research is the first to show that they also may be remarkably effective in at-risk patients facing surgical stress and recovery pain that often is addressed with opioids,” said Anjali Dixit, M.D., MPH, a pediatric anesthesiologist at Stanford University, California. “This is helping us learn more about how to optimally treat OUD patients so that their surgical and post-surgical pain is well-controlled, while also making sure we are minimizing their risk of relapse and overdose.”

Researchers analyzed 4,030,032 surgeries performed between 2008 and 2020 from the Merative MarketScan Commercial Database, a nationwide sample of data from patients with both employer-sponsored and Medicare Advantage insurance. The analysis reviewed overdoses and other complications (such as OUD-related hospitalization or infection) that occurred in the three months after surgery for the 25 most common surgeries, including knee and hip replacement, hysterectomy and gallbladder removal.

Of the over 4 million surgeries, 26,827 were performed on patients who had a history of OUD, 9,699 (36%) of whom used OUD medications in the month before surgery and 17,128 (64%) who did not. OUD patients who did not use OUD medications were 4.2 times more likely to overdose or have an OUD-related infection or hospitalization than those who did not have the disorder, according to the study. OUD patients who used OUD medications did not experience a statistically different risk of opioid-related adverse events compared to those who did not have the disorder.

As many as 7.6 million people in the U.S. live with OUD, according to research, and that number continues to grow. Only 20% of people with OUD currently use OUD medications, said Dr. Dixit. She noted the number of people in the study who used OUD medications was likely higher, because they had access to commercial insurance and therefore, better access to care. The researchers also want to look at other populations such as those on Medicaid, because they may be sicker and have less access to care.

“The national efforts to increase access to OUD medications is good news for people with OUD, including those who need surgery,” said Dr. Dixit. “The next step is to determine if a particular medication or regimen is better than another.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY^® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

Newswise — Researchers from the United States, Brazil, and Spain, including scientists with the Fralin Biomedical Research Institute at VTC, published an analysis in a special edition of the British Medical Journal with a timely and controversial recommendation: It’s time for an international shift in the way we think about ultra-processed food.

“There is converging and consistent support for the validity and clinical relevance of food addiction,” said Ashley Gearhardt, the article’s corresponding author and a psychology professor at the University of Michigan. “By acknowledging that certain types of processed foods have the properties of addictive substances, we may be able to help improve global health.”

While people can give up smoking, drinking, or gambling, they can’t stop eating, said co-author Alexandra DiFeliceantonio, assistant professor at the Fralin Biomedical Research Institute. The challenge, and the still open and controversial question, is defining which foods have the most potential for addiction and why.

Their work was published Oct. 10 in Food For Thought, a special edition of the British Medical Journal, a high-impact publication and one of the world’s oldest medical journals.

DiFeliceantonio is also associate director of the Fralin Biomedical Research Institute’s Center for Health Behaviors Research and an assistant professor in the Department of Human Nutrition, Foods, and Exercise in the College of Agriculture and Life Sciences at Virginia Tech.

Not all foods have the potential for addiction, the researchers said. 

“Most foods that we think of as natural, or minimally processed, provide energy in the form of carbohydrate or fat — but not both,” DiFeliceantonio said.

Researchers gave the example of an apple, salmon, and a chocolate bar. The apple has a carbohydrate to fat ratio of roughly 1-to-0, while the salmon has a ratio of 0-to-1. In contrast, the chocolate bar has a carbohydrate to fat ratio of 1-to-1, which appears to increase a food’s addictive potential.

“Many ultra-processed foods have higher levels of both. That combination has a different effect on the brain,” DiFeliceantonio said. Researchers also called for more study into the role of food additives used in industrial processing. Key takeaways from the analysis include:

• Behaviors around ultra-processed food, which are high in refined carbohydrates and added fats, may meet the criteria for diagnosis of substance use disorder in some people. Those behaviors include less control over intake, intense cravings, symptoms of withdrawal, and continued use despite such consequences as obesity, binge eating disorder, poorer physical and mental health, and lower quality of life.
• This global health challenge needs to consider geographic differences. In a review of 281 studies from 36 different countries, researchers found ultra-processed food addiction is estimated to occur in 14 percent of adults and 12 percent of children. In some countries, ultra-processed foods are a needed source of calories. Even within high-income countries, food deserts and other factors could limit access to minimally processed foods. People facing food insecurity are more reliant on ultra-processed foods, and therefore more likely to demonstrate food addiction, researchers noted.
• Viewing some foods as addictive could lead to novel approaches in the realm of social justice, clinical care, and public policy. Policies implemented in Chile and Mexico — taxes, labelling, and marketing — are associated with decreases in caloric intake and purchases of foods high in sugar, saturated fat, and salt, for example. And in the United Kingdom, a salt-reduction program was associated with a decline in deaths from stroke and coronary artery disease.

The co-authors represent international expertise on food addiction, nutrition physiology, gut-brain reward signaling, food policy, behavioral addiction, and eating disorders. They call for more study and science surrounding ultra-processed foods,

“Given how prevalent these foods are — they make up 58 percent of calories consumed in the United States — there is so much we don’t know.” DiFeliceantonio said. 

The researchers call for more study into such areas as: how complex features of ultra-processed foods combine to increase their addictive potential; better defining which foods can be considered addictive; differences among countries and communities, including disadvantaged communities; the value of public-health messaging; and clinical guidelines for preventing, treating, and managing addiction to ultra-processed foods.

In addition to Gearhardt and DiFeliceantonio, authors include Nassib B. Bueno, a professor at Universidade Federal de Alagoas in Brazil; Christina A. Roberto, associate professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine; and Susana Jiménez-Murcia and Fernando Fernandez-Aranda, both professors in the Department of Clinical Psychology at the University Hospital of Bellvitge in Spain.

DiFeliceantonio is not the only Virginia Tech researcher whose work appears in the special edition. Valisa Hedrick, an associate professor with the Department of Human Nutrition, Foods, and Exercise, is also featured. Hedrick’s work highlights nutritional uncertainty and the need for more research into non-sugar sweeteners.

Newswise — Five years after cannabis legalization in Canada, it appears to be a mixed success, with social justice benefits outweighing health benefits, write authors in a commentary published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230808.

Cannabis use was legalized in Canada in October 2018, with the goal to improve cannabis-related public health and safety, and reduce youth access and illegal activities related to cannabis. There was concern among some health professionals that legalization could lead to adverse health effects in Canadians.

“Limited evidence exists to support benefits as they relate to the original stated policy objectives of improving cannabis users’ and public health,” writes Dr. Benedikt Fischer, Simon Fraser University, Vancouver, BC, with coauthors. “At this stage, cannabis legalization in Canada appears not to have been the public health disaster anticipated by some of its opponents, but it cannot be described as a comprehensive or unequivocal success for public health either.”

Evidence indicates that cannabis use, cannabis-related emergency department visits and admissions, and cannabis-related impaired driving have stayed the same or increased. On the other hand, most cannabis consumers now obtain their cannabis from legal, rather than illegal, sources, and cannabis-related arrests, along with personal burdens from stigma and possible criminal records among adults and youth have decreased substantially. The authors assert these are important social justice benefits that may have indirect positive health effects.

“These major societal benefits of legalization must be included in any systematic assessments of the policy reform’s impacts,” write the authors.

Ongoing monitoring of cannabis use in adults, youth and high-risk people, and major health harms such as cannabis use disorder, cannabis-related injuries, hospital admissions or emergency department visits, and related crime and other socioeconomic indicators is needed to better understand the impact of legalization.

Newswise — With the explosion of online platforms and advertising, the scourge of gambling is a growing problem affecting people of all ages. This week world-leading researchers, campaigners, support bodies, and people with lived experience are set to gather in Bristol to raise awareness of the pressing issues and call for urgent national policy change, as the UK Government continues to consider reforming the Gambling Act.

The Bristol Hub for Gambling Harms Research will host its first-ever annual International Interdisciplinary Colloquium on Thursday 12 October at the M Shed in Bristol.

Former England football player Peter Shilton OBE, who was hooked on gambling for 45 years, will be speaking at the event with his wife Steph, a qualified therapist who helped him overcome the costly addiction. 

Steph said: “Without studies and research none of us can claim to be experts in our subjects as we have no basis. The research is imperative for those foundations in building our knowledge.” 

Peter added: “We are really looking forward to attending and speaking at this event. Steph and myself are proud to be patrons of the grassroot football study and to support the terrific work being undertaken by the University of Bristol for research into gambling harms.”

Other speakers include Lord Foster of Bath, who was an MP for more than 20 years and now chairs Peers for Gambling Reform, the largest cross-party group in the House of Lords and investigative journalist and author Rob Davies, acclaimed for exposing the insidious business practices within the UK’s gambling industry.

Lord Foster of Bath said: “I have met too many people who have experienced gambling harm and families of loved ones who have committed suicide because of it. It’s clear large numbers of people are affected daily, including children.

“The Government’s White Paper includes some important measures to address this issue, including recognition at last that this is a serious public health issue. But there are also many shortcomings. I’m extremely disappointed so very little is being done to limit the way we’re all bombarded with gambling advertising and direct marketing.

“The promotion of gambling products has grown exponentially, with an annual spend of £1.5billion, along with providers using ever more sophisticated means to attract new customers, persuade existing ones to spend more, and keep them hooked. This activity needs much greater scrutiny and regulation.”

More than 150 gambling harms experts covering health, policy, regulations, and marketing, from countries including Germany, Belgium, Ireland and Singapore are attending to explore and progress how to build capacity in gambling harms research. Delegates will consider factors drawing people into harmful gambling, how this deepens socio-economic inequalities and what innovative interventions can help combat these trends.

Professor Agnes Nairn, Co-Director of the Bristol Hub for Gambling Harms Research and Pro Vice-Chancellor for Global Engagement at the University of Bristol, said: “Experience of gambling harms is a worldwide phenomenon. However, the cultural context, provision of support and approach to regulation varies dramatically across countries. We are delighted to bring together experts from 13 nations to debate how strong interdisciplinary research can help tackle this growing issue.”

Counsellors from charity Ara (Addiction Recovery for All), which have a base in Bristol, and similar organisations will also be joining the event to raise awareness of the help available, treatment providers, as well as offering peer support. A representative from the Youth Advisory Board of GamCare will share insights on how gambling affects young people and what they want to change.

Last month University of Bristol-led research revealed the extent gambling messages saturate UK media coverage and social media during the opening weekend of the English Premier League football season. The investigation found that football fans are bombarded with 11,000 gambling messages during a single weekend, with only a fifth (20.6%) of these messages found to include gambling harm reduction messages and even fewer (18.7%) that featured age warnings.

Co-lead researcher Dr Raffaello Rossi, Lecturer in Marketing at the University of Bristol, who is also part of the event, said: “Self-regulation of the gambling industry is completely failing.  The gambling industry’s primary goal is profit, not public welfare. So, of course they will not implement measures that actually reduce gambling and their profits. This is why the UK Government have to step up and start protecting people from predatory and excessive gambling marketing.

“Other countries such as Italy, Spain, Poland, Netherlands and Belgium have all started to introduce harsh restrictions and even bans on gambling marketing.  It is shocking that the White Paper has completely ignored the need for stricter gambling marketing curbs – something strongly supported by the public.”

Last year the University of Bristol launched the Bristol Hub for Gambling Harms Research to lead pioneering multidisciplinary research into the wide-reaching effects of gambling harms.

The independent hub, funded by a grant of £4million from GambleAware, facilitates world-leading research to improve understanding of gambling harm as a growing public health issue which needs greater scrutiny and regulation.

Newswise — Certain characteristics of people seeking remission from alcohol use disorder (AUD) are linked to their choice of recovery meeting, a new study suggests. Informal peer recovery groups—mutual-help organizations—play a crucial role for many individuals with AUD or other drug disorders. Such groups are proliferating and differ substantially in approach. SMART Recovery meetings emphasize individual empowerment through learned, evidence-based therapeutic techniques, while Alcoholics Anonymous (AA) meetings offer a 12-step program emphasizing a “higher power” and social support. While AA attendees have been studied, little is known about who engages with SMART Recovery (an acronym for Self-Management and Recovery Training). A better understanding of who engages with differing informal support programs could improve matching and referrals. For the study in Alcohol: Clinical & Experimental Research, investigators in Massachusetts explored the characteristics of those attending SMART Recovery versus AA meetings compared to people attending both and those not seeking support from either group.

From 2019 to 2022, researchers recruited 361 adults with AUD who lived in either New England or San Diego and were starting a recovery attempt: 71 attended SMART meetings only, 73 AA only, 53 both SMART and AA, and 160 neither SMART nor AA. The participants were assessed for demographics, life satisfaction and spirituality, and various resources and barriers (including their confidence about staying sober, commitment to sobriety, and access to social support and other resources). They were also assessed for their histories of substance use and cravings, mental health diagnoses and distress, certain medications, use of treatment and recovery services, experience of negative alcohol consequences, including criminal justice involvement, and more. The investigators used statistical analysis to explore associations between these factors at a single point in time across the four groups (SMART, AA, Both, and Neither).

The four groups differed substantively in their demographics. The SMART-only participants were more likely to be White, married, have higher education and income, and be in full-time employment than the AA attendees. Although participants in all three groups attending meetings had similar levels of AUD symptom severity and psychiatric histories, the SMART attendees reported less heavy and less consequential drinking patterns and reduced spiritual inclinations than those attending AA or Both meetings. Hispanic participants were overrepresented in SMART (possibly because of recruitment in San Diego), while Black participants were almost completely absent. The AA and Both groups reported more alcohol consumption on drinking days (10 drinks) than the SMART and Neither groups (7 drinks). The AA and Both group participants attended many more meetings than the SMART group—possibly reflecting the greater availability of AA meetings and the attendees’ relative severity of alcohol-related problems—and were much more likely to have experienced treatment programs and community recovery services. Nevertheless, the participants of the three mutual-help groups reported comparable access to helpful resources and barriers and similar quality of life, functioning, and well-being. Participants who did not attend meetings had less clinically severe AUD.

Certain aspects of the SMART Recovery philosophy, approach, or content appear to appeal to people with less severe histories of alcohol-related impairment and greater socioeconomic resources and stability. More research is needed on why SMART Recovery does not seem to engage Black participants. The study findings may not apply to broader populations.

Who affiliates with SMART Recovery? A comparison of individuals attending SMART Recovery, Alcoholics Anonymous, both, or neither. J. Kelly, S. Levy, M. Matlack, B. Hoeppner. (pp xxx)

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Newswise — The past decade has seen a significant increase in marijuana use among U.S. college students. This increase has coincided with notable changes in national and local cannabis laws and policies, and perceptions of the associated drug’s risk over the same period. However, cannabis use by students continues to be a public health challenge throughout the country. Universities have long relied on education programs to address these risks; however, many of these programs have limitations and fail to consider some of the modern risk factors for cannabis use among young adults.

A new study led by Benjamin Montemayor, PhD, assistant professor in the Department of Health Behavior at the Texas A&M University School of Public Health, looks into cannabis use patterns, motivations and risk factors for cannabis use among college students at a large public university in the southeastern United States. Results were published in the journal Cannabis.

Although many states have decriminalized or outright legalized cannabis, the drug remains illegal at the federal level and as such is largely banned on university campuses. Despite changes in perceived risks associated with cannabis use, using it can be problematic for college students, especially when used together with alcohol. For example, cannabis use is frequently associated with poorer academic performance and health outcomes such as substance use disorders, with upwards of 70 percent of college students who actively use marijuana meeting the criteria for a potential cannabis use disorder.

To further explore reasons and risk factors for cannabis use among college students, the researchers surveyed 99 students who had violated campus drug use policy. The survey asked students to report how many days of the past month they had used cannabis and how much cannabis (in grams) they typically used per day. The researchers also asked respondents to report their reasons for using cannabis, such as using it to relax or relieve tension, as a sleeping aid, as part of socializing with friends, to experiment or to escape from problems. The researchers finally asked respondents about various risk factors for cannabis use, such as how many students at their university they think also use cannabis, how their friends and families might view them decreasing their cannabis use, perceptions of risks associated with using cannabis regularly, concurrent alcohol co-use, and at what age they started using cannabis. The researchers examined the associations between the quantity of cannabis use per day and the various risk factors, controlling for demographic data such as sex, race and ethnicity, age, years in school and fraternity or sorority membership.

The researchers found that the top three reasons for cannabis use reported by students were to relax or relieve tension, to feel good or get high, and to have a good time with friends. The average age at which respondents reported they started using cannabis was 17 years. On average, students used cannabis on seven out of the past 30 days, with 8 percent reporting daily use of cannabis. The students used more than a quarter of a gram per day, on average, with 40 percent reporting having consumed at least one gram of cannabis per day on days they used. More than half of the sample of students also used alcohol in the past month.

The researchers found that students in the study believe nearly half (47 percent) of all other students on campus also use cannabis and believe their friends or family would think it’s a good idea for them to personally reduce their cannabis use. Finally, the researchers found a low perception of risk overall associated with cannabis use.

Analysis of the data found an association between cannabis use quantity per day and frequency, with students who reported higher quantity of cannabis use per day also reporting more days per month of cannabis use. The study also found a significant association between cannabis use and perceived risk, with more use per day associated with those who had the lowest perceived risk scores. Finally, race and ethnicity were reported to have a significant association with cannabis use, with students who identified as a racial or ethnic minority reporting greater cannabis use.

Modern cannabis interventions fail to address the complicated nature of cannabis in our society partly because of a lack of current information on the diverse ways students are experimenting with cannabis (for example, dabbing and gravity bongs) and the associated hazards. Cannabis has been around for centuries. To be effective, intervention programs should address the specific sociocultural contexts that impact cannabis use, such as culture, religion and values, and the way in which national and state policies conflict and potentially generate permissive norms that cannabis use is allowed on campus.

The findings of this study highlight the need for cannabis intervention programs that address psychosocial risk factors and motivations for cannabis use that are tailored to meet the needs of different racial, ethnic and cultural groups. Better understanding the motivations behind marijuana use and the various factors and perceptions associated with use in college students could help reduce risks presented by drug use.

“Policies are changing, and cannabis use at large is outpacing the rate at which research is coming out,” Montemayor said. “If we fail to adapt our programs to keep up with the way cannabis use has become an ingrained part of our society then we are failing to prioritize the health and safety of the student body.”

Montemayor also cited the Department of Health and Human Service’s recommendation to reclassify cannabis from a Schedule 1 drug, where it has been since the 1970s alongside heroin and crack, to a Schedule 3 drug as one reason why designing and implementing cannabis use programs on campus is as important an issue as it ever has been for universities around the nation.

Newswise — Researchers at University of California San Diego School of Medicine and the Salk Institute for Biological Studies have created a unique, cell-by-cell atlas of the amygdala, a small structure deep within the brain that plays a crucial role in controlling emotional responses to drugs. The findings, published October 5, 2023 in Nature Neuroscience, helped the researchers identify a potential new treatment for cocaine addiction, a disease that is poorly understood at the molecular level and has virtually no approved pharmacological treatments.

“There are some drugs that can help treat other addictions, such as those to opioids or nicotine, but there are currently no safe and effective drugs approved for cocaine addictions,” said co-senior author Francesca Telese, PhD, an associate professor in the Department of Psychiatry at UC San Diego School of Medicine. “These findings help address that problem and could also point to universal molecular mechanisms of addiction that we haven’t understood until now.”

Cocaine is a widely used illicit drug and addiction to cocaine is a major public health concern, associated with a rising number of overdose deaths and a high rate of relapse. Despite the threat cocaine addiction poses, not every person who uses cocaine develops an addiction. According to the National Institute on Drug Abuse, an estimated 4.8 million people used cocaine in 2021, while only 1.4 million people had a cocaine use disorder.

“Some people use cocaine recreationally and never develop an addiction, while others are extremely susceptible to addiction after very little exposure to the drug or may relapse even after years of abstinence,” said Telese “Our long-term goal is to understand why there are these inter-individual differences in drug addiction behavior.”

The researchers studied brain samples from rats that had been allowed to self-administer cocaine for an extended period before being cut off from the drug for a period of abstinence. These samples were obtained from the cocaine brain bank at UC San Diego, established by study co-authors Abraham A. Palmer, PhD, and Olivier George, PhD, both professors in the Department of Psychiatry at UC San Diego School of Medicine.

“The cocaine brain bank is an exceptional resource and was invaluable for this study because it allowed us to study a cohort of rats with a large amount of genetic variety, which mimics the diversity we see in human populations,” said Telese. “Further, using a model of cocaine addiction where rats administered the drug to themselves let us look at the connection between our molecular discoveries and actual addiction behaviors.”

The team used single-cell sequencing to determine what genes were expressed in individual cells from the rats’ amygdala, a part of the brain that is central to processing emotions and is highly active in people with addictions.

“Being able to look at individual amygdala cells from rats with different vulnerabilities to addiction was an asset for our study because we wanted to understand how specific cell populations of the amygdala contribute to addiction development,” Telese added.

To make sense of the large amount of data generated through their sequencing experiments, Telese collaborated closely with bioinformatics expert and co-senior author Graham McVicker, PhD, an associate professor at the Salk Institute of Biological Studies and an assistant adjunct professor in the Department of Cellular & Molecular Medicine at UC San Diego School of Medicine. Jess Zhou, a UC San Diego graduate student working with McVicker, developed the bioinformatics workflow needed to assemble their sequencing data into a molecular atlas of the rat amygdala.

The results revealed never-before-seen connections between addiction behaviors and genes involved in energy metabolism.

“This tells us that energy metabolism may be playing a key role in the activity of neurons in the amygdala and that this effect could be contributing to addiction-like behaviors,” said Telese. “This is a brand-new way of thinking about the molecular biology of cocaine addiction.”

In addition to identifying molecular factors that influence cocaine addiction behaviors, the researchers were able to test a drug in the rats that helped reverse these behaviors by targeting an enzyme involved in both energy metabolism and signaling between neurons.

“The fact that we were able to link our findings at the cellular level to behaviors exhibited in the rats and were even able to modify these behaviors with a drug puts us one step closer to understanding the extremely complex mechanisms in the brain driving addiction and relapse,” added Telese.

The researchers are now working on larger sample-size studies that can help determine how much of the effects they observed were based on preexisting genetics in the rats and how much were based on responses to extensive cocaine usage.

“This research suggests that preexisting genetics may play a much bigger role in addiction than we’ve previously understood,” said Telese. “Unraveling these genetics will be key to improving personalized medicine for addictions. If we don’t understand the risk of relapse in individual people, we can’t fully understand the disease.”

Co-authors of the study include: Giordano de Guglielmo, Marsida Kallupi, Narayan Pokhrel, Apurva S. Chitre, Daniel Munro, Hai-Ri Li and Lieselot LG Carrette at UC San Diego, Aaron J. Ho at the Salk Institute for Biological Studies and Pejman Mohammadi at Scripps Research and University of Washington.

The study was funded, in part, by the National Institutes of Health (grants U01DA050239, F31DA056226, U01DA043799, P50DA037844 and R01GM140287), the Brain and Behavior Research Foundation and the Tobacco Related Disease Research Program (grant T31KT1859 UC).

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Disclosures: Abraham A. Palmer holds a patent related to the use of GLO1 inhibitors (US20160038559, active).